Hypoalbuminaemia in amen 11 year old Doberman

Re: Hypoalbuminaemia in amen 11 year old Doberman

shanley barber — Wed, 30 Jan 2013 21:35:54 GMT

Hi all, thanks for your help. The albumin is 17, the TP is normal (sorry, am at home now). As for the casts, I'm pretty sure, but I'm no urologist. I thought that the reduced renal blood flow from dehydration might cause some tubular necrosis, so I didn't think it was pathognominic for PLN He does have gi signs ( D and V) but presented to a colleague 2 weeks ago with just weight loss, nothing else. I've kept urine for a UPC ratio but am waiting for the outcome of the scan, as cost is an issue. Thanks again, Shanley

Re: Hypoalbuminaemia in amen 11 year old Doberman

Christopher Saul — Wed, 30 Jan 2013 16:33:58 GMT

I would agree that pyelonephritis is less likely given the SPG yes. I would still want a urinary prot : creat ratio as part of the key diagnostic steps in the work up of hypoalbuminaemia.

Shanley, can you post the full biochem pannel? how severe is the hypoalbuminaemia? what were globs doing? Generally speaking ( but this is NOT an absolute rule) PLE will often cause a panhypoproteinaemia rather than a hypalbminaemia.

An important question is was your haematology done on an in-house analyser? In my experience I've had some pretty far out results with these, you really can't replace a man (or woman) and a microscope.

In general the differentials for hypoalbuminaemia are as follows:

*Starvation/malnutirition/ malabsorbtive diseases

*Protein losing enteropathy (any GI signs?)

*Protein losing nephropathy

*Liver disease

*Third spacing ( i.e. peritonitis / pleuritis)

I would advise your next steps are:-

Get a full blood count from a reference lab if you haven't already done so

Urinalysis including Prot :Creat ratio (too rule in/out a PLN )

Bile acid stimulation test

x ray/ultrasound (in particular looking for signs of effusions and the state of the liver, but also to look at things like intestinal wall thicknesses)

B12/folate/TLI

If the albumin is very low the dog is at risk of thromboembolic disease, so I'd use ultra low dose aspirin

Hope this helps

Chris

Re: Hypoalbuminaemia in amen 11 year old Doberman

Kate Richardson — Wed, 30 Jan 2013 13:17:01 GMT

David, do you not think pyelonephritis with a USG> 1.050 is unlijkely and the azotaemia thus more likely due to dehydration?

I agree pleuritis/pericarditis unlikely but could be mild or focal; just thoughts really on septic foci.

Re: Hypoalbuminaemia in amen 11 year old Doberman

David Mills — Wed, 30 Jan 2013 12:16:11 GMT

OP mentions granular casts on urinalysis - how sure are you of these, and if very then I'd be looking at kidney issues, namely pyelonephritis. The azotaemia can be surprisingly moderate or in some cases non-existent. What are globulin levels like? Proteinuria? I'd be going for an abdo scan with necessary FNAs as next stage. Pleuritis and pericarditis unlikely with no compatible clinical signs.

Re: Hypoalbuminaemia in amen 11 year old Doberman

Kate Richardson — Wed, 30 Jan 2013 09:20:35 GMT

How low is the albumin? And to follow what is the globulin? Its got some fancy name I can't think of, but if you have a hyperglobulinaemia from inflammation you can get a secondary hypoalbuminaemia, I think its to do with globulins being produced preferentially. So even if your TP is normal the ratio of glob to alb can be significant. Probably not clear cut in this case though as your azotaemia and USG suggest significant dehydration which will affect your protein levels so would need to repeat bloods once hydrated.

Malnutirtion would be the only other cause I can think of just now other than those you already have. What was the protein in the urine? Are you or have you run a UPC?

Intestinal disease or liver disease would be my top diffs based on what you know so far, so scan good idea. Plus Bile acid stim. I don't like to jump to nasty immediately usually, but with a massive neutrophilia I would be looking for a neoplasm somewhere or a focus of inflammation/infection such as peritonits/pleuritis as suggested above or even a pericarditis. What was the neutrophil count and did they look toxic or band neutrophils?

Re: Hypoalbuminaemia in amen 11 year old Doberman

Michael Woodhouse — Tue, 29 Jan 2013 23:59:36 GMT

Pancreatitis is on the list.

Re: Hypoalbuminaemia in amen 11 year old Doberman

Utlendigur — Tue, 29 Jan 2013 22:17:35 GMT

Hypoalbuminaemia with massive neutrophilia could indicate something like peritonitis (or pyothorax). I have seen a few that weren't pyrexic, particularly localised or longstanding ones ones.